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2.
Indian J Public Health ; 63(2): 119-127, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31219060

RESUMO

Background: The increasing burden of noncommunicable diseases (NCDs) urges continuous survey of risk factors in different population groups. Objectives: The study was conducted to assess the prevalence and determinants of behavioral and biological risk factors of NCDs, in rural tribal population. Methods: A community-based cross-sectional study was conducted from June 2014 to May 2015, in rural Siliguri, among 172 tribal people aged 25-64 years selected by multistage cluster random sampling using WHO-STEPS instrument. Study participants were interviewed for sociodemographic and behavioral risk factors, and biological measurements were taken. Descriptive and logistic regression analyses were performed to explore the determinants of risk factors. Results: Among the study participants, the prevalence of current tobacco use and alcohol use were 69.8% and 40.7%, respectively; 96.5% consumed unhealthy diet and 2.9% were physically inactive. The prevalence of abdominal obesity and overweight were 26.2% and 12.2%, respectively. Odds of tobacco use were significantly raised among men (adjusted odds ratio [AOR]: 47.7 [95% confidence interval (CI) 11.1, 203.9]) and increased age of the participants. Men showed higher odds of alcohol consumption (AOR: 13.4 [95% CI 4.6, 38.9]). Odds of abdominal obesity were higher among older participants, whereas lower odds were found among men (AOR: 95% CI 0.11 [0.0, 0.5]) compared to women. Conclusions: Most of the behavioral and biological risk factors of NCDs were quite high among tribal population of rural Siliguri except physical inactivity. Increasing awareness about NCDs through locally accepted and culturally appropriate strategies need to be implemented in the study area.


Assuntos
Grupos Étnicos/psicologia , Doenças não Transmissíveis/epidemiologia , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Estudos Transversais , Dieta/efeitos adversos , Dieta/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/etnologia , Doenças não Transmissíveis/psicologia , Obesidade Abdominal/complicações , Obesidade Abdominal/epidemiologia , Fatores de Risco , Comportamento Sedentário , Fatores Sexuais , Uso de Tabaco/efeitos adversos , Uso de Tabaco/epidemiologia
3.
Int J Public Health ; 64(6): 821-830, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31062035

RESUMO

OBJECTIVES: To identify clusters of risk behaviors among Brazilian adults, by sex, and to associate clusters with sociodemographic factors and self-perception of health. METHODS: We assessed 46,785 adults from the Brazilian National Health Survey. The risk behaviors were low consumption of fruits and vegetables-LFV (< 5 times/week), physical inactivity-PI (< 150 min/week), smoking (yes/no) and excessive consumption of alcohol-EA (5 doses for male, 4 doses for female). We used Venn diagram, cluster analysis and multinomial regression models. RESULTS: We found 9 clusters. The cluster of four risk behaviors was more common in males (3.2% vs. 0.83%). Despite a greater potential for aggregation of behaviors in females (O/E = 2.48) than in males (O/E = 1.62), the women were less likely to have all risk behaviors jointly (OR 0.24, 95% CI 0.19; 0.31), and this was found for the other clusters. In general, Brazilian black/brown, younger, with low education level and who had a self-perception of bad health, were more likely to engage in clusters of risk behaviors. CONCLUSIONS: The prevalence of Brazilian adults engaging in clusters of risk behaviors is high, mainly among males, those who reported a bad health and with low socioeconomic status.


Assuntos
Comportamentos Relacionados com a Saúde , Inquéritos Epidemiológicos/estatística & dados numéricos , Doenças não Transmissíveis/psicologia , Assunção de Riscos , Adulto , Brasil/epidemiologia , Análise por Conglomerados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
5.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(4): 406-411, 2019 Apr 10.
Artigo em Chinês | MEDLINE | ID: mdl-31006199

RESUMO

Objective: To estimate the health-related quality of life (HRQOL) and health-adjusted life expectancy (HALE) which were associated with chronic non-communicable diseases (NCDs) in people from Guangdong province of China. Methods: Data on both NCDs prevalence and EuroQol-5 Dimensions-3 Levels measured HRQOL were gathered from the Fifth National Health Survey in Guangdong province, 2013. Logistic regression model and multiple linear regression model were employed to explore the impact of NCDs on HRQOL. Life expectancy (LE) and HALE were used to evaluate the comprehensive impact of chronic diseases on population health. Results: A total of 68 550 inhabitants were included in the analysis. Graded logistic regression showed that the impact of chronic diseases on all dimensions of quality of life was statistically significant after adjusting for social demographic characteristics. The greatest health impact was on the pain/discomfort health dimension [OR=4.48 (95%CI:4.20-4.77)], followed by anxiety/depression[OR=3.95 (95%CI: 3.62- 4.31)], daily activities [OR=3.69 (95%CI: 3.37-4.04)], mobility [OR=3.63 (95%CI: 3.34-3.94)]and ability on self-care [OR=3.30 (95%CI: 2.98-3.66)]. Losses of LE and HALE caused by NCDs were 12.7 and 14.6 years respectively while the overall expected gain was 3.8 years in HALE, when NCDs were taken away. Conclusions: Our data showed that NCDs had shortened the healthy life span of patients through reducing the HRQOL and also causing heavy disease burden on both patients with NCDs and the communities. Health-care related policies on NCDs need to be developed, for the elderly, in particular.


Assuntos
Doença Crônica/psicologia , Expectativa de Vida , Doenças não Transmissíveis/psicologia , Qualidade de Vida/psicologia , Idoso , China/epidemiologia , Doença Crônica/etnologia , Humanos , Doenças não Transmissíveis/etnologia , Prevalência
6.
BMC Psychiatry ; 19(1): 81, 2019 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-30813922

RESUMO

BACKGROUND: Depression is a global problem, affecting populations worldwide, but is too often under-diagnosed. The identification of depression among patients with diabetes is important because depression is prevalent in this group and can complicate diabetes management. OBJECTIVES: The aim of the study was to determine the sensitivity and specificity of the PHQ-9 in the detection of depression among patients with type-2 diabetes mellitus attending non-communicable diseases (NCD) clinics in Malawi. METHODS: We conducted a validation study of the Patient Health Questionnaire (PHQ-9) among 323 patients with type-2 diabetes mellitus who attended two NCD clinics in one of the 28 districts of Malawi. The participants were screened consecutively using the nine-item PHQ-9 in Chichewa by a research assistant and completed a diagnostic interview using the Structured Clinical Interview for DSM-IV (SCID) for depression with a mental health clinician. We evaluated both content validity based on expert judgement and criterion validity of the Patient Health Questionnaire (PHQ-9) based on performance against the SCID. The PHQ-9 cutpoint that maximized sensitivity plus specificity was selected to report test characteristics. RESULTS: Using the SCID for depression, the prevalence of minor or major depression was 41% (133/323). The internal consistency estimate for the PHQ-9 was 0.83, with an area under the receiver operator curve (AUC) of 0.93 (95% CI, [0.91-0.96]). Using the optimal cut-point of ≥9, the PHQ-9 had a sensitivity of 64% and a specificity of 94% in detecting both minor and major depression, with likelihood ratio-positive = 10.1 and likelihood ratio negative =0.4 as well as overall correct classification (OCC) rate of 81%. CONCLUSIONS: This is the first validation study of the PHQ-9 in NCD clinics in Malawi. Depression was highly prevalent in this sample. The PHQ-9 demonstrated reasonable accuracy in identifying cases of depression and is a useful screening tool in this setting. Health care workers in NCD clinics can use the PHQ-9 to identify depression among their patients with those having a positive screen followed up by additional diagnostic assessment to confirm diagnosis. TRIAL REGISTRATION: PACTR201807135104799 . Retrospectively registered on 12 July 2018.


Assuntos
Depressão/psicologia , Diabetes Mellitus Tipo 2/psicologia , Doenças não Transmissíveis/psicologia , Questionário de Saúde do Paciente/normas , Adulto , Instituições de Assistência Ambulatorial , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Nível de Saúde , Humanos , Malaui , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Inquéritos e Questionários/normas
8.
J Nerv Ment Dis ; 207(2): 53-58, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30672877

RESUMO

A vast number of veterans with posttraumatic stress disorder (PTSD) have chronic somatic comorbidities. However, their relationship with quality of life (QoL) has received little attention. We aimed to compare QoL of veterans with similar intensity of PTSD but different number of chronic somatic disorders. Of 129 veterans, 78% had at least one somatic disorder, and they reported lower QoL across all domains than veterans without somatic comorbidities. The greatest effect size was observed on social relationship (d = 0.65), it was notable on environment (d = 0.4) and psychological health (d = 0.38), and it was not relevant on physical health (d = 0.05). There was a negative correlation between the number of somatic disorders and scores on psychological health (rs = -0.217, p = 0.014), social relationships (rs = -0.248, p = 0.005), and environment (rs = -0.279, p = 0.001). The QoL of war veterans decreases significantly with the number of comorbid somatic conditions, particularly on the nonphysical domains of QoL.


Assuntos
Distúrbios de Guerra/psicologia , Relações Interpessoais , Doenças não Transmissíveis/psicologia , Qualidade de Vida/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Adulto , Distúrbios de Guerra/epidemiologia , Comorbidade , Croácia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Veteranos/estatística & dados numéricos
9.
Int J Health Plann Manage ; 34(1): e203-e218, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30187582

RESUMO

When facing adverse health from noncommunicable disease (NCD), households adopt coping strategies that may further enforce poverty traps. This study looks at coping after an adult NCD death in rural Bangladesh. Compared with similar households without NCD deaths, households with NCD deaths were more likely to reduce basic expenditure and to have decreased social safety net transfers. Household composition changes showed that there was demographic coping for prime age deaths through the addition of more women. The evidence for coping responses from NCDs in low- and middle-income countries may inform policy options such as social protection to address health-related impoverishment.


Assuntos
Adaptação Psicológica , Família/psicologia , Doenças não Transmissíveis/mortalidade , Adolescente , Adulto , Países em Desenvolvimento , Características da Família , Feminino , Financiamento Pessoal , Gastos em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/economia , Doenças não Transmissíveis/psicologia , População Rural , Fatores Socioeconômicos , Adulto Jovem
10.
Rev Bras Epidemiol ; 21(suppl 1): e180002, 2018 Nov 29.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30517453

RESUMO

OBJECTIVE: To analyze trend estimates on the prevalence of risk and protective behaviors for chronic noncommunicable diseases in adolescents, according to data from the National School Health Survey in 2009, 2012 and 2015. METHODS: Data from the three cross-sectional studies in Brazilian capitals and the Federal District were used. In total, 173,310 adolescents enrolled in the ninth grade of elementary school were interviewed, with average age of 14 years. The prevalence of indicators of protective (consumption of beans and fruit; physical education classes at school; practice of physical activity for 60 minutes or more) and risk factors (consumption of candies and soft drinks; use of cigarettes and alcohol in the last 30 days; drug testing) were estimated through linear regression. RESULTS: There was a significant increase (p < 0.05) in the prevalence of fruit consumption and in the reduction of bean, soft drinks and candies consumption, as well as the consumption of alcoholic beverages and cigarettes. However, an increase in the prevalence of illicit drug experimentation was observed. Discussion: Despite the tendency to reduce risk factors, prevalences are high when compared with other sociocultural realities. CONCLUSION: The school is an important area of access to the adolescent public, and it is necessary to encourage school health promotion programs to reduce health risk behaviors, as well as to stimulate protective ones.


Assuntos
Saúde do Adolescente/tendências , Inquéritos Epidemiológicos/estatística & dados numéricos , Doenças não Transmissíveis/epidemiologia , Assunção de Riscos , Adolescente , Comportamento do Adolescente/psicologia , Brasil/epidemiologia , Doces/estatística & dados numéricos , Bebidas Gaseificadas/estatística & dados numéricos , Exercício/psicologia , Comportamento Alimentar/psicologia , Feminino , Humanos , Masculino , Doenças não Transmissíveis/psicologia , Prevalência , Fatores de Proteção , Fatores de Risco , Fumar Tabaco/psicologia , Consumo de Álcool por Menores/psicologia
11.
PLoS One ; 13(11): e0205745, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30462648

RESUMO

BACKGROUND: Out of pocket payment (OOPP), is the major health financing mechanism in South Asia region. With the rising burden of non-communicable diseases (NCDs), the region is facing a high financial burden. However, the extent and nature of economic impact caused by treatment and management of NCDs at the household level is yet unknown. METHOD: We conducted a systematic review using Medline and Embase databases. Only peer-reviewed quantitative studies published between January 2000 to December 2016 assessing OOPP or catastrophic health expenditure or impoverishment or financial coping strategy due to at least one of the four major NCDs-cardiovascular diseases(CVDs), diabetes, cancer, chronic respiratory disease in South Asia region was included in the review. The review is registered in PROSPERO no: CRD42017059345. RESULTS: A total of 21 studies (of 2693 records identified) met the inclusion criteria. The economic impact was most frequently studied in CVDs and in terms of OOPP. The studies collectively indicated high OOPP, higher likelihood of catastrophic expenditure and impoverishment for inpatient care for these major NCDs which was visible in all income levels. Borrowing and selling off assets were the most common forms of coping strategies adopted and varied inconsistently between urban and rural households. The true extent of the economic impact, however, remains difficult to determine due to methodological heterogeneity regarding outcomes reported and measures employed for calculation of OOPP, catastrophic expenditure, and impoverishment across these four major NCDs and between nations. CONCLUSION: The economic impact due to treatment and management of CVDs, diabetes, cancer and chronic respiratory diseases among households in South Asia seems dire. Given the lack of sufficient evidence the review stresses the need for further research in the region to develop evidence-informed nationally tailored prepayment mechanisms covering NCDs to reduce economic vulnerability and standardization of tools measuring the economic impact for generating comparable estimates.


Assuntos
Adaptação Psicológica , Características da Família , Doenças não Transmissíveis/economia , Doenças não Transmissíveis/psicologia , Ásia , Humanos
12.
BMJ Open ; 8(11): e024503, 2018 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-30391921

RESUMO

OBJECTIVE: Non-communicable diseases (NCDs) impose a significant health and economic burden. This study aimed to assess the differential attendance patterns of public to different healthcare professionals and gauge the opinions of key stakeholders towards screening of NCDs by allied healthcare professionals. DESIGN: Questionnaires were designed piloted and subsequently completed by key stakeholders. The results were analysed descriptively. SETTING: Public questionnaires were undertaken in a West Midlands transport station and Public Markets. High street dental and community pharmacy settings were selected via local clinical and research networks. Healthcare professionals were identified using professional networks and were emailed a web link to an online survey. PARTICIPANTS: 1371 members of the public, 1548 patients and 222 healthcare professionals (doctors general practitioner (GP), dentists general dental practitioner (GDP) and pharmacists) completed the questionnaires. OUTCOME MEASURES: The outcome was to compare attendance patterns at GDP and GP practices to determine whether different populations were more likely to access different healthcare professionals, this included determining when patients were last screened for NCDs by their GP. Additionally, the willingness of patients to undergo the required intervention and the opinions of stakeholders regarding the concept of screening for the specified NCDs in general dental and community pharmacy settings were also explored. RESULTS: 12% of patients who reported seeing a GDP biannually reported that they had not had contact with a GP in the last year. Over 61% of the public reported attending a GDP biannually, of this group 48% reported having never had a check-up at the GP. All stakeholders surveyed were in broad support of the concept of allied health professionals undertaking screening for specific general health conditions. CONCLUSIONS: This study has established that allied healthcare professionals may have access to different cohorts of the population to GPs. If GDPs and pharmacists have access to patients who are not using healthcare services elsewhere, they may be ideally placed to risk assess, and where appropriate offer preventative advice and test for NCDs.


Assuntos
Atitude , Assistência Odontológica/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Doenças não Transmissíveis/prevenção & controle , Farmácias/estatística & dados numéricos , Participação dos Interessados , Adolescente , Adulto , Idoso , Pessoal Técnico de Saúde/estatística & dados numéricos , Estudos Transversais , Feminino , Medicina Geral/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/psicologia , Inquéritos e Questionários , Reino Unido , Adulto Jovem
13.
Chin J Integr Med ; 24(12): 886-890, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30334200

RESUMO

The number of people with chronic diseases rises rapidly in recent years worldwide. Except for drug medication, mind-body exercises are indispensable for chronic disease management. Traditional Chinese practice (TCP), as an integrative intervention, is known as an effective means to keep in good health and fitness, as well as help regulate emotion. This paper introduces the domestic and overseas studies on effectiveness of TCP for chronic diseases, and explores the key action links from three aspects, including functional training of multiple-joint guided by consciousness, relieving psychological risk factors, improving respiratory and digestive function, blood and lymph circulation through respiratory training, and regulation of nerve, metabolic, and immune system. Finally, the authors discussed how to integrate TCP in the chronic disease management, and put forward that the practice methods and evaluation standard should be assessed academically.


Assuntos
Medicina Tradicional Chinesa , Doenças não Transmissíveis/terapia , Doença Crônica , Assistência à Saúde , Humanos , Doenças não Transmissíveis/psicologia , Fatores de Risco , Revisão Sistemática como Assunto , Resultado do Tratamento
14.
Qual Life Res ; 27(11): 2799-2814, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29980994

RESUMO

PURPOSE: Over the past decade, a changing spectrum of disease has turned chronic non-communicable diseases (CNCDs) into the leading cause of death worldwide. During the 2015 in China, there were more than 6.6 million deaths from NCDs, which was the highest rate around the world. In the present study, we performed a systematic review to analyze the health-related quality of life (HRQoL) according to EQ-5D-3L instrument in patients with different kinds of CNCDs in China. METHODS: We searched PubMed, Embase, Web of Science, Cochrane Library, VIP, WanFang Data, and CNKI databases up to April 12, 2018, to identify all relevant studies that reported on HRQoL assessed by EQ-5D-3L instrument in Chinese patients with CNCDs. Expert consultation and hand-searching of reference lists from retrieved studies were employed to identify additional references. The variation of mean utility values, EQ-VAS score ranges, and responses for each EQ-5D dimension described in relevant studies were extracted. RESULTS: A total of 5027 English-language articles and 618 Chinese-language articles were identified, among which 38 articles met full inclusion criteria. These 38 studies involved 18 kinds of CNCDs. In this review, the health utility for diabetes mellitus ranged from 0.79 to 0.94 (EQ-5D VAS scores from 61.5 to 78.6), hypertension from 0.78 to 0.93 (70.1-77.4), coronary heart disease from 0.75 to 0.90 (71.0-77.0), chronic obstructive pulmonary disease from 0.64 to 0.80 (55.0-67.0), epilepsy from 0.83 to 0.87 (78.3-79.6), cerebral infarction from 0.51 to 0.75 (49.7-79.0), while children cerebral palsy was 0.44 (27.3). CONCLUSIONS: EQ-5D-3L is widely used in studies of HRQoL associated with CNCDs in China. Our results suggest that many factors may influence the measurement results of health utilities, including age, gender, sample source, comorbidities, rural/urban, and EQ-5D-3L value sets.


Assuntos
Doenças não Transmissíveis/psicologia , Qualidade de Vida/psicologia , Grupo com Ancestrais do Continente Asiático , Doença Crônica , Feminino , Humanos , Masculino , Inquéritos e Questionários
15.
Med Sci Monit Basic Res ; 24: 93-95, 2018 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-29904042

RESUMO

The greatest challenge facing medicine today involves the so-called non-communicable diseases (NCDs). This is true regardless of whether one's location is considered high-income, middle-income, or low-income. Basic research at all "OMICs" system levels will be significant in uncovering causal links that create NCD vulnerabilities in mind, brain, body, and society. Therefore, meeting this 21st century challenge by improving NCD management and prevention around the world will rely on advancement in this type of basic research.


Assuntos
Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/psicologia , Humanos
16.
PLoS One ; 13(6): e0199602, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29928044

RESUMO

BACKGROUND: People living with HIV are increasingly burdened by noncommunicable diseases (NCDs) as a result of the NCD susceptibility that accompanies increased life expectancy and the rising global prevalence of NCDs. Health systems are being strengthened and programs are being developed to address this burden, often building on HIV care strategies and infrastructure or through integrated care models. HIV remains a stigmatized condition and the role of HIV stigma in the provision of NCD care is not well understood. METHODS: We conducted a scoping literature review of both peer reviewed and grey literature to identify evidence of the role of HIV stigma in the NCD-care continuum (prevention, diagnosis, care seeking, retention in care, and adherence to treatment of NCDs). We searched PsychInfo and Pubmed and conducted additional searches of programmatic reports and conference abstracts. Included studies were published in English within the past decade and examined HIV-related stigma as it relates to NCD-care or to integrated NCD-and HIV-care programs. RESULTS: Sixteen articles met the inclusion criteria. Findings suggest: fear of disclosure, internalized shame and embarrassment, and negative past experiences with or negative perceptions of health care providers negatively influence engagement with NCD care; HIV stigma can adversely affect not only people living with HIV in need of NCD care, but all NCD patients; some NCDs are stigmatized in their own right or because of their association with HIV; integrating NCD and HIV care can both reduce stigma for people living with HIV and a present a barrier to access for NCD care. CONCLUSION: Due to the dearth of available research and the variability in initial findings, further research on the role of HIV stigma in the NCD-care continuum for people living with HIV is necessary. Lessons from the field of HIV-stigma research can serve as a guide for these efforts.


Assuntos
Infecções por HIV/complicações , Infecções por HIV/terapia , Doenças não Transmissíveis/terapia , Discriminação Social , Estigma Social , Infecções por HIV/psicologia , Humanos , Doenças não Transmissíveis/psicologia , Discriminação Social/psicologia
17.
AIDS Care ; 30(sup2): 5-10, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29848002

RESUMO

HIV and non-communicable diseases (NCD) are co-epidemics in South Africa. Comorbid individuals must engage in lifelong care. Postpartum HIV-positive women in South Africa are at high risk of dropping out of HIV care. We explored healthcare utilization among postpartum women requiring chronic management of HIV and NCD. From August - December 2016, we enrolled 25 women in Soweto, South Africa, and conducted one-time interviews. All participants were adult (≥18 years), HIV-positive, postpartum, and diagnosed with a NCD that required further evaluation after delivery. We developed a conceptual model that describes how maternal factors, interaction with environments, and social networks influence follow up engagement. Barriers to follow-up included separate visit days, increased time commitment, transportation and logistics, unfamiliar clinic environments, and disrespectful staff. Factors facilitating patient engagement included social support and partner disclosure. Women were more likely to turn to friends and family for advice regarding HIV or the NCD, rather than a clinic. Women prioritized infant care after delivery, suggesting that baby care may be an entry point for improving maternal care after delivery. Our results support advocating for better integration of services at the primary care level as a method to improve continuity of care for both women and children.


Assuntos
Continuidade da Assistência ao Paciente , Prestação Integrada de Cuidados de Saúde , Infecções por HIV/tratamento farmacológico , Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Complicações Infecciosas na Gravidez/tratamento farmacológico , Retenção nos Cuidados , Serviços de Saúde da Mulher/organização & administração , Adulto , Fármacos Anti-HIV/uso terapêutico , Revelação , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Entrevistas como Assunto , Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/psicologia , Período Pós-Parto , Gravidez , Pesquisa Qualitativa , Parceiros Sexuais , Apoio Social , África do Sul/epidemiologia
18.
J Med Internet Res ; 20(5): e162, 2018 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-29728346

RESUMO

BACKGROUND: Noncommunicable diseases (NCDs) account for 70% of all deaths in a year globally. The four main NCDs are cardiovascular diseases, cancers, chronic pulmonary diseases, and diabetes mellitus. Fifty percent of persons with NCD do not adhere to prescribed treatment; in fact, adherence to lifestyle interventions is especially considered as a major challenge. Smartphone apps permit structured monitoring of health parameters, as well as the opportunity to receive feedback. OBJECTIVE: The aim of this study was to review and assess the effectiveness of app-based interventions, lasting at least 3 months, to promote lifestyle changes in patients with NCDs. METHODS: In February 2017, a literature search in five databases (EMBASE, MEDLINE, CINAHL, Academic Research Premier, and Cochrane Reviews and Trials) was conducted. Inclusion criteria was quantitative study designs including randomized and nonrandomized controlled trials that included patients aged 18 years and older diagnosed with any of the four main NCDs. Lifestyle outcomes were physical activity, physical fitness, modification of dietary habits, and quality of life. All included studies were assessed for risk of bias using the Cochrane Collaboration`s risk of bias tool. Meta-analyses were conducted for one of the outcomes (glycated hemoglobin, HbA1c) by using the estimate of effect of mean post treatment with SD or CI. Heterogeneity was tested using the I2 test. All studies included in the meta-analyses were graded. RESULTS: Of the 1588 records examined, 9 met the predefined criteria. Seven studies included diabetes patients only, one study included heart patients only, and another study included both diabetes and heart patients. Statistical significant effect was shown in HbA1c in 5 of 8 studies, as well in body weight in one of 5 studies and in waist circumference in one of 3 studies evaluating these outcomes. Seven of the included studies were included in the meta-analyses and demonstrated significantly overall effect on HbA1c on a short term (3-6 months; P=.02) with low heterogeneity (I2=41%). In the long term (10-12 months), the overall effect on HbA1c was statistical significant (P=.009) and without heterogeneity (I2=0%). The quality of evidence according to Grading of Recommendations Assessment, Development and Evaluation was low for short term and moderate for long term. CONCLUSIONS: Our review demonstrated limited research of the use of smartphone apps for NCDs other than diabetes with a follow-up of at least 3 months. For diabetes, the use of apps seems to improve lifestyle factors, especially to decrease HbA1c. More research with long-term follow-up should be performed to assess the effect of smartphone apps for NCDs other than diabetes.


Assuntos
Aplicativos Móveis/normas , Doenças não Transmissíveis/psicologia , Qualidade de Vida/psicologia , Smartphone/instrumentação , Humanos , Estilo de Vida
19.
Chronobiol Int ; 35(8): 1045-1053, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29642757

RESUMO

Later chronotype (i.e. evening preference) and later timing of sleep have been associated with greater morbidity, including higher rates of metabolic dysfunction and cardiovascular disease (CVD). However, no one has examined whether chronotype is associated with mortality risk to date. Our objective was to test the hypothesis that being an evening type is associated with increased mortality in a large cohort study, the UK Biobank. Our analysis included 433 268 adults aged 38-73 at the time of enrolment and an average 6.5-year follow-up. The primary exposure was chronotype, as assessed through a single self-reported question-defining participants as definite morning types, moderate morning types, moderate evening types or definite evening types. The primary outcomes were all-cause mortality and mortality due to CVD. Prevalent disease was also compared among the chronotype groups. Analyses were adjusted for age, sex, ethnicity, smoking, body mass index, sleep duration, socioeconomic status and comorbidities. Greater eveningness, particularly being a definite evening type, was significantly associated with a higher prevalence of all comorbidities. Comparing definite evening type to definite morning type, the associations were strongest for psychological disorders (OR 1.94, 95% CI 1.86-2.02, p = < 0.001), followed by diabetes (OR 1.30, 95% CI 1.24-1.36, p = < 0.001), neurological disorders (OR 1.25, 95% CI 1.20-1.30, p = < 0.001), gastrointestinal/abdominal disorders (OR 1.23, 95% CI 1.19-1.27, p = < 0.001) and respiratory disorders (OR 1.22, 95% CI 1.18-1.26, p = < 0.001). The total number of deaths was 10 534, out of which 2127 were due to CVD. Greater eveningness, based on chronotype as an ordinal variable, was associated with a small increased risk of all-cause mortality (HR 1.02, 95% CI 1.004-1.05, p = 0.017) and CVD mortality (HR 1.04, 95% CI 1.00-1.09, p = 0.06). Compared to definite morning types, definite evening types had significantly increased risk of all-cause mortality (HR 1.10, 95% CI 1.02-1.18, p = 0.012). This first report of increased mortality in evening types is consistent with previous reports of increased levels of cardiometabolic risk factors in this group. Mortality risk in evening types may be due to behavioural, psychological and physiological risk factors, many of which may be attributable to chronic misalignment between internal physiological timing and externally imposed timing of work and social activities. These findings suggest the need for researching possible interventions aimed at either modifying circadian rhythms in individuals or at allowing evening types greater working hour flexibility.


Assuntos
Ciclos de Atividade , Ritmo Circadiano , Expectativa de Vida , Doenças não Transmissíveis/mortalidade , Adulto , Idoso , Causas de Morte , Comorbidade , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/psicologia , Admissão e Escalonamento de Pessoal , Prevalência , Prognóstico , Medição de Risco , Fatores de Risco , Comportamento Social , Fatores de Tempo , Reino Unido/epidemiologia , Tolerância ao Trabalho Programado
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